Vertigo is one of the most common causes of dizziness. It is distinctly different from other types of dizziness. With vertigo, a patient feels a spinning or moving sensation. The room or floor can feel like it is moving or the patient may feel a spinning or off balance sensation. Vertigo can sometimes be associated with nausea or vomiting. If severe, walking can be affected with the patient having staggering or inability to walk.

Vertigo has many causes but the most common include head trauma, ear infection and Meniere’s disease. Vertigo can frequently occur spontaneously, without a cause, and this is called benign positional vertigo (BPV.) Temporary vertigo can be experienced after getting off an amusement park ride or going out boating (sea sickness.) Meniere’s disease is a condition of sudden episodes of severe vertigo associated with progressive hearing loss. Stroke is a relatively rare cause of dizziness.

The cause of benign positional vertigo is quite simple. In the inner ear, our balance center, are the semicircular canals. These canals contain fluid that moves when we move, stimulation motion sensitive hair-nerve cells. It is this mechanism that gives us balance and allows up to keep from falling. Inside the area that contains the semicircular canals are small calcium crystals. When one of these crystals breaks off from the wall of the labyrinth, they move into the semicircular canal. With changes in head position such as rolling over, getting out of bed, bending, looking up or looking suddenly to one side, the calcium crystal (canalith) moves, abnormally disturbing motion-sensitive hair cells. This is what gives the sensation of vertigo or feeling dizzy. The vertigo associated with BPV is usually short in duration. In more severe cases patients can be disabled. A condition known as labyrinthitis is a severe form of vertigo, caused by inflammation of the labyrith. It needs to be differentiated from stroke. A CT or MRI brain scan should be performed.

Treatment of vertigo consists mostly of medication control of symptoms. Meclizine is the standard drug used for symptomatic treatment of vertigo. It is safe, effective and nonhabit forming. The usual dose is 25 mg one to four times daily. Drowsiness is the major side effect. For patients who do not respond to meclizine, very low dose Valium (1 mg) can frequently be effective.

There is nonpharmaceutical treatment of vertigo. This requires the affected patient to do Epley Exercises 2-3 times daily. This has the effect of repositioning the calcium crystal and fatiguing vertigo response. This You Tube video has an excellent demonstration of these exercises. The American Academy of Neurology recently published guidelines for treatment of vertigo. The medical evidence is strongly in favor of physician administered canalith repositioning. This was the most effective treatment available.

In summary, most causes of vertigo are benign but the symptoms can be disabling. Sometimes it is important to rule out more serious causes of vertigo such as stroke or brain tumor. Affected individuals should seek out care from a neurologist or other physician familiar with the treatment of vertigo.

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Many patients over the age of 65 complain of memory loss and are concerned they have dementia. Others attribute their memory loss to aging. While there is a very mild degree of memory loss associated with aging, it is usually not significant. For example, forgetting where you put your keys or where you parked your car. These are not serious memory problems. A more problematic degree of memory loss, while not dementia, is called Mild Cognitive Impairment (MCI). MCI is characterized by an increase level of forgetfulness. There are two primary types of MCI: (1) Amnestic MCI (2) Non-amnestic MCI. In patients affected with amnestic MCI, they have significant memory and recall difficulty. There is a stronger association with this type of MCI with Alzheimer’s disease. Non-amnestic MCI usually does not progress to Alzheimer’s disease but may go on to other types of dementia. The good news is that about fifty percent of all patient’s with MCI never progress to Alzheimer’s or any other dementia. MCI can also spontaneously improve and clear.

The American Academy of Neurology published criteria for the diagnosis of MCI: (1) Individuals reporting their awareness of memory difficulty – preferably confirmed by a spouse or child; (2) Measurable memory loss greater than would be expected for age; (3) Normal general thinking and reasoning skills; (4) Ability to perform routine daily activities. Frequently patients with MCI have specific areas in which they are having memory trouble whereas patients affected with dementia have more global memory difficulties. Also quite frequently, patients with dementia are unaware of having any memory problem at all.

Risk factors for MCI and mild memory loss include such things as high blood pressure, lower educational levels, lack of physical and mental activities and vascular disease. Vascular dementia is seen in patients that have had multiple small strokes. Abnormally low blood pressure, particularly in patients with significant brain vascular disease (hardening of the arteries) can be a cause of reversible memory loss. Depression can cause a condition of memory loss known as pseudo-dementia syndrome of depression. Fortunately this is treatable and the “memory loss” is reversible in this condition.

In those patients affected with MCI, they can go on to develop dementia, usually Alzheimer’s disease. The true incidence is difficult to measure and ranges between 27-65% depending on which study one reads. Some studies have shown that the use of memory loss medications such as donzepil (AriceptĀ®) can help improve memory function and potentially slow the progression of memory loss. It should be noted that in patients over the age of 70, approximately 12% will have some degree of memory difficulty. This is highly variable from patient to patient.

In summary, if you have a sense that you have memory difficulty, do not attribute it to normal aging. Consider seeing a neurologist trained in evaluating memory disorders and Alzheimer’s disease. You have everything to gain by improving your quality of life.

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